Original Articles Long-Term Anabolic-Androgenic Steroid Use Is Associated With Left Ventricular Dysfunction

Background—Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure. Methods and Results—We performed 2D tissue-Doppler and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n12) and otherwise similar AAS nonusers (n7). AAS users (median [quartile 1, quartile 3] cumulative lifetime AAS exposure, 468 [169, 520] weeks) closely resembled nonusers in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups; however, AAS users had significantly lower LV ejection fraction (50.6 % [48.4, 53.6] versus 59.1 % [58.0%, 61.7%]; P0.003 by two-tailed Wilcoxon rank sum test), longitudinal strain (16.9 % [14.0%, 19.0%] versus 21.0 % [20.2%, 22.9%]; P0.004), and radial strain (38.3% [28.5%, 43.7%] versus 50.1 % [44.3%, 61.8%]; P0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (55%). AAS users also demonstrated decreased diastolic function compared to nonusers as evidenced by a markedly lower early peak tissue velocity (7.4 [6.8, 7.9] cm/s versus 9.9 [8.3, 10.5] cm/s; P0.005) and early-to-late diastolic filling ratio (0.93 [0.88, 1.39] versus 1.80 [1.48, 2.00]; P0.003). Conclusions—Cardiac dysfunction in long-term AAS users appears to be more severe than previously reported and ma